Zinc (Zn) is an essential trace element second only to iron in abundance and biological importance. It plays critical roles in enzymatic activity, gene expression, cellular integrity, immune regulation, skeletal growth, and neurodevelopment. During gestation, zinc supports cellular proliferation and neuronal maturation, with fetal accretion peaking in the third trimester. Preterm infants, who miss this late-gestation transfer, are uniquely predisposed to deficiency, compounded by high metabolic demands, renal and gastrointestinal immaturity, increased urinary and gastrointestinal losses, and comorbidities such as bronchopulmonary dysplasia or necrotizing enterocolitis. While breast milk provides highly bioavailable zinc, its concentrations decline over time, and preterm milk, although more bioavailable than formula, contains less absolute zinc. Deficiency in preterm infants can manifest as dermatologic and oral lesions, diarrhea, growth failure, alopecia, and impaired immunity. Diagnostic challenges stem from reliance on serum zinc levels, which reflect only a fraction of total body zinc, although reductions in alkaline phosphatase and altered copper metabolism may provide additional insights. Evidence supports zinc supplementation in preterm and low birthweight infants, with doses exceeding 3 mg/kg/day associated with improved growth, head circumference, and reduced morbidity, including lower rates of sepsis, bronchopulmonary dysplasia, and necrotizing enterocolitis. Multiple zinc salts are bioavailable, with citrate and bisglycinate showing superior palatability and absorption. While supplementation is generally safe, excessive zinc can interfere with copper homeostasis and lead to hematologic and neurologic complications, highlighting the importance of biochemical monitoring. Zinc is thus a critical micronutrient in neonatal care, and targeted supplementation offers both short- and long-term benefits for high-risk preterm infants. Early recognition of deficiency, careful dosing, and vigilant monitoring are essential to optimizing outcomes while avoiding trace element imbalances.